【One case per day】 Cysticercosis cerebral cysticercosis

58-year-old man with a history of epilepsy

What is the most likely diagnosis?

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【Answer】

4.

【Discussion】

Cysticercosis of the brain

【Overview】

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The most important manifestation of the disease in the central nervous system - neurocysticercosis (NCC)

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(1) Humans are the final hosts of tapeworms in the gastrointestinal tract

(2) The pig is the intermediate host

(3) When the eggs or larvae of tapeworm host or undercooked pork are ingested into the human body through the fecal-oral route, human tapeworm disease can develop

(4) Cysticerci (larval sac) matures in the organ

Skin, skeletal muscle, central nervous system (CNS), heart, eyes

【Clinical Manifestations】

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Epilepsy

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Chronic headache

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Malignant and vomiting

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Changes in mental status

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Changes in vision

【Imaging Performance】

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Usually located within the brain parenchyma

May be located in the ventricles or subarachnoid space

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Degenerative sac calcification, oval or cigar-like

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CT is the preferred examination method for cerebral cysticercosis (NCC).

(1) Calcification

Calcified sacs are usually not accompanied by peripheral edema

(2) No intensified cystic lesions, with or without peripheral edema

(3) Placeholder effect

(4) Hydrocephalus

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MRI can show cystic lesions located in the ventricular system

Lateral ventricles, third and fourth ventricles

【Differential diagnosis】

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Coccidioidomycosis

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Toxoplasma gondii

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Tumor

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Trichinellosis

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Tuberculosis (TB)

【Treatment】

Insect repellents

【Complications】

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Encephalopathy

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Obstructive hydrocephalus

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Sequelae of steroids or anticonvulsants

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Calcified sacs can cause epilepsy

【Prognosis】

Most patients have a good prognosis

Cysticercosis:

The white arrow shows that there are many scattered calcified cysticercii in the brain parenchyma without peripheral inflammation
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The right shoulder joint shows multiple cigar-like calcifications in the muscles and also indicates cysticercidae
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